Raff Lauren A, Waller Holly, Griffin Russell L, Kerby Jeffrey D, Bosarge Patrick L
Lauren A. Raff, MD • Chief Resident • Department of Surgery • University of Alabama at BirminghamHolly Waller, MPH, RN • Director • Trauma and Burn Services • University of Alabama at BirminghamRussell L. Griffin, PhD • Assistant Professor of Epidemiology • University of Alabama at Birmingham Center for Injury SciencesJeffrey D. Kerby, MD, PhD • Director • Division of Acute Care Surgery Care • University of Alabama at Birmingham Patrick L. Bosarge, MD • Assistant Professor • Department of Surgery • Director • Trauma Critical Care Fellowship.
Adv Skin Wound Care. 2016 Jul;29(7):329-34. doi: 10.1097/01.ASW.0000484064.86180.18.
To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients.
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Describe the previous PrU research, scope of the problem, and methodology of the study.2. Explain the results of the study identifying PrU risk factors for trauma patients.
Pressure ulceration prevention has been emphasized over the past several years in inpatient hospital settings with subsequent decreases in the development of pressure ulcers (PrUs). However, there remains a subset of trauma and burn patients that develop PrUs despite standard screening methodology and prophylaxis. This study determines the conditions that predict development of pressure ulcers (PrUs) despite conventional prophylaxis and screening.
Demographic and PrU data were collected over a 5-year period from June 2008 to May 2013. Patients diagnosed with PrUs upon arrival in the trauma bay were excluded from analysis. An ordinal logistic regression of PrU stage was used to estimate odds ratios (ORs) and associated 95% confidence intervals (CIs) for the association between characteristics of interest and odds of a PrU. A backward selection process was used to select the most parsimonious model.
During the study period, 14,616 trauma patients were admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63-9.01), mechanical ventilation (OR, 1.95; CI, 1.23-3.10) and age 40 to 64 (OR, 2.09; CI, 1.24-3.52) and age ≥ 65 (OR, 4.48; CI, 2.52-7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32-0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than -6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development.
Spinal injuries, older than age 40, and mechanical ventilation predict the development of PrUs for a subset of patients, despite conventional prophylaxis and screening. Advanced prevention methods, such as low-air-loss mattresses for these patient subgroups should be considered immediately upon identification of these risk factors during the hospital course.
介绍一项关于创伤患者发生压疮（PrUs）危险因素的研究信息。
本继续教育活动面向对皮肤和伤口护理感兴趣的医生和护士。
目标/结果：参加本教育活动后，参与者应能更好地：1. 描述先前关于压疮的研究、问题范围及研究方法。2. 解释该研究确定创伤患者压疮危险因素的结果。
在过去几年中，住院环境中一直强调预防压疮，随后压疮的发生率有所下降。然而，仍有一部分创伤和烧伤患者，尽管采用了标准的筛查方法和预防措施，仍会发生压疮。本研究确定了在常规预防和筛查的情况下，预测压疮发生的条件。
在2008年6月至2013年5月的5年期间收集人口统计学和压疮数据。到达创伤病房时被诊断为压疮的患者被排除在分析之外。采用压疮分期的有序逻辑回归来估计感兴趣特征与压疮发生几率之间的比值比（ORs）及相关的95%置信区间（CIs）。使用向后选择过程来选择最简约的模型。
在研究期间，共收治14,616例创伤患者并获取了可用数据。共有124例（0.85%）符合纳入标准的患者在住院期间发生了压疮。与压疮发生相关的因素包括脊柱简明损伤量表（AIS）>3（OR，5.72；CI，3.63 - 9.01）、机械通气（OR，1.95；CI，1.23 - 3.10）、年龄40至64岁（OR，2.09；CI，1.24 - 3.52）以及年龄≥65岁（OR，4.48；CI，2.52 - 7.95）。有趣的是，头部损伤AIS>3对压疮的发生有保护作用（OR，0.56；CI，0.32 - 0.96）。定义为收缩压<90 mmHg和碱缺失小于 -6的低血压和休克与压疮的发生无关。此外，体重指数与压疮的发生无关。
对于一部分患者，尽管采取了常规预防和筛查措施，但脊柱损伤、40岁以上以及机械通气仍可预测压疮的发生。在医院病程中一旦识别出这些危险因素，应立即考虑对这些患者亚组采用先进的预防方法，如使用低气耗床垫。
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